Healthcare Provider Details

I. General information

NPI: 1114901337
Provider Name (Legal Business Name): MARY ELIZABETH CAHILL CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 FRANKLIN RD SE
MARIETTA GA
30067-7803
US

IV. Provider business mailing address

777 FRANKLIN RD SE
MARIETTA GA
30067-7803
US

V. Phone/Fax

Practice location:
  • Phone: 770-732-6007
  • Fax: 770-732-8242
Mailing address:
  • Phone: 770-732-6007
  • Fax: 770-732-8242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN083997
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: